Evidence-Based Practice: Principles and Research Variables

Evidence-Based Practice (EBP) Fundamentals

Key Components of EBP

Clinical Expertise: The ability to use skills and past experience to rapidly identify each patient's unique health state and weigh potential interventions.

Research Evidence: Clinically relevant research into diagnostic tests, prognostic markers, and interventions.

Patient Characteristics: The unique preferences, concerns, and expectations of each patient, which must be integrated into decision-making.

Understanding Medical Paradigms

What is a Shift in Medical Paradigms?

A formal set of rules for interpreting clinical research must complement clinical training.

What are Insufficient Grounds for Clinical Decision-Making?

Intuition, unsystematic clinical experience, and pathophysiological rationale.

The Process of Evidence-Based Practice

What are the Steps in EBP?

1. A patient creates a need for information.
2. The information need is converted into an answerable question.
3. Evidence is consulted.
4. Evidence is appraised.
5. Clinical performance is evaluated.

Define Evidence

Evidence refers to the results of clinically relevant research, often from the basic sciences of medicine, but especially from patient-centered research.

Patient-Centered Research Focuses On

The accuracy and precision of diagnostic tests, the predictive power of prognostic markers, and the efficacy of therapeutic regimens.

Fundamental Principles of EBP

1. Evidence is never enough: Individual patient values and cost-benefit analysis must also be considered.
2. Not all evidence is equal: There is a hierarchy of evidence, depending on the type of question being asked.

Why is EBP Essential?

1. Information overload.
2. A gap between experience and performance.
3. Variations in practice due to geography.
4. A gap between knowing something to be true and its implementation.

Example: Clinical Decision-Making

What determines the clinical decision to treat some but not other individuals with hypertension? A physician's year of graduation from medical school.

EBP Goal and End Result

For a specific clinical question, gather and critically appraise evidence, then translate critical appraisals into direct clinical action, and assess performance.

Understanding Research Variables

Independent Variable (IV)

An independent variable is a condition, intervention, or characteristic predicting or causing a given outcome. It is something 'manipulated' by the researcher and has two or more levels (groups or conditions to be explored).

Example of an Independent Variable

A study comparing the effectiveness of spinal manipulation (SMT) versus a walking program for patients with low back pain. The independent variable is the treatment group, with two levels:

1. SMT
2. Walking program

Conceptual Definition

A conceptual definition relates to or is based on mental concepts. Example: Low back pain = degree of discomfort.

Operational Definition

An operational definition defines a variable according to its unique meaning in a study. Independent Variables (IVs) are operationally defined according to how they are manipulated by the researcher. Dependent Variables (DVs) are operationally defined by describing the details related to the method of measurement.